Characteristics and Outcomes of Kidneys Procured from Donors With KDPI > 80%

M. Doshi, I. Hall, F. Weng, B. Schroppel, J. Ficek, R. Hasz, H. Thiessen-Philbrook, R. Formica, P. Reese, C. Parikh.

TRIBE Consortium, New Haven, CT.

Meeting: 2015 American Transplant Congress

Abstract number: 47

Keywords: Cadaveric organs, Donors, Kidney, marginal, Outcome

Kidneys procured from donors with KDPI>80% are often biopsied and pumped, yet frequently discarded. The accuracy of these quality assessment tools remain controversial but contribute heavily in terms of discard. Our objective was to compare characteristics and transplant outcomes of kidneys from 641 donors with KDPI>80%. Donors for whom at least one of the kidneys were discarded due to with technical issues were excluded. Donors were grouped by number of kidneys discarded: A) none (378, 59%), B) one (75, 12%) and C) both (188, 29%). The donors in group B and C were more likely to be older, hypertensive, diabetic and had higher terminal creatinine (p<0.05). Urinary levels of NGAL, KIM-1 and IL-18 obtained at procurement were not different between the groups. The kidneys of donors in group B and C were more frequently biopsied and less frequently to be pumped

Kidney Biopsy and Pump Characteristics from Donors with KDPI > 80%

Variable	A) 0 discarded (n=756)	B) 1 discarded (n=150)	C) 2 discarded (n=376)	p*
Kidney biopsy	593 (78%)	130 (87%)	329 (88%)	<0.001
Glomerulosclerosis >20%	21 (3%)	15 (11%)	148 (44%)	<0.001
Pumped	392 (52%)	70 (47%)	152 (40%)	<0.001
1 hr resistance	0.27 (0.22,0.37)	0.29 (0.25,0.46)	0.35 (0.26,0.5)	<0.001
1 hr flow	101 (79,122)	97 (71,110)	78 (56, 104)	<0.001

Values are n (%) or median (IQR); *Chi-square for categorical and Kruskal-Wallis for continuous variables. There was significant discard based on biopsy findings and pump parameters i.e. 1^st hour renal resistance and flow rate [table 1]. Rates of delayed graft function, DGF (38% vs. 41%; p=0.5) and 1-year graft failure (7% vs. 11%; p=0.29) were statistically not different between groups A and B. Subgroup analyses for 6-month graft function by number of kidneys transplanted from a donor, donor kidney injury by creatinine, biopsy findings and pump parameters showed no significant differences, whereas 6-month eGFR was lower in recipients with DGF . These data suggest that more kidneys from donors with KDPI >80% can be considered for transplantation. Longer follow-up studies confirming adeqauate graft function are needed to recommend increasing their use.

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